AFTA Award to Susan McDaniel for Innovative Contributions to Family Therapy

Presented by Lyman Wynne at the Annual Meeting, San Diego, June 24, 2000

I am delighted and honored to present the AFTA Award for Innovative Contributions to Family Therapy to Susan McDaniel. During two decades of observing her creativity and initiatives, my assessment of her confirms what Bill Doherty has said to me about her special contribution: "Few family therapists over the past fifty years have had the distinction of moving the paradigm of the field in a decisive new direction. Through her pioneering work in medical family therapy, Susan McDaniel has done just that."

It is worthwhile for us to pause to consider the context and scope of the change taking place with the entry, or re-entry, of family therapists into the rooms of the medically ill. During the 1950s and up until about 1965 - pre-history to most present-day family therapists - most early family therapists were occupied with fighting with psychoanalysis but were relatively comfortable in medical settings, including psychiatric hospitals, and made many highly popular plenary presentations at major medical and psychiatric meetings. Schizophrenia, adolescent disturbance, and medical problems such as anorexia and diabetes were excitedly considered symptoms of family system dysfunction. But as these hypotheses were scrutinized in more detail, as psychiatry become much more oriented to diagnostic entities and to psychopharmacology, and as medicine become more occupied with biotechnical procedures, family therapists emigrated to another continent. For the great majority of family therapists newly entering the field after 1965, biology, medicine, and the psychiatry of serious/persistent disorders became a rather hostile foreign land. To these family therapists, entry to this land required hard-to-get visas and payment of high tariffs, and was assumed not to be of much interest anyway.

This was the context when Susan McDaniel moved to Rochester in 1980. In retrospect, she had had a good background for exploring new territory. She had been reared in the South, in a family where graceful feminine accomplishment was valued. Her genogram is loaded with physicians with whom she had become comfortable as a non-physician. And she had been exposed to provocatively deviant, creative family therapists such as Harry Goolishian.

During the 1970s as Chair of Psychiatry in Rochester, I had made repeated futile attempts to establish a family therapist presence in the new Department of Family Medicine. Putting "family" into Family Medicine seemed especially appropriate in the homeland of George Engel's biopsychosocial medical model, which had gained widespread attention in medical and psychiatric education (though not in family therapy education), particularly after his landmark articles on the subject in 1977 and 1980. Somehow, soon after her arrival in Rochester, Susan regarded physicians in Family Medicine as appropriate persons to meet, and from whom she might obtain referrals and even set up a collaborative relationship. I don't know how much this fit in with her marriage to David Siegel, a distinguished pediatrician, with whom she has collaborated in rearing two flourishing daughters.

At any rate, by 1982 she had become appointed as Co-Director of Psychosocial Medicine Education in the Department of Family Medicine, together with Tom Campbell, the primary care physician with whom she has had a delightfully good-humored, productive, sparring collaboration ever since. One of the truly remarkable qualities that I have both observed and experienced with Susan is her extraordinary ability to reach out collaboratively with a great diversity of folks, negotiating differences respectfully, and enhancing reciprocal creativity.

During the 1980s Susan opened up new vistas for collaborative care by family therapists and primary care physicians. Her passionate involvement in mentoring new trainees in both fields was carried out with continuous attention to developing and clarifying new concepts for showing how no biomedical event occurs without psychosocial repercussions, and no psychosocial event occurs without biological processes. This was a far cry from the psychosocial fixation of family therapists, which dualistically paralleled the biological fixation of many psychiatrists and other physicians. Meanwhile, in 1983 Don Bloch founded Family Systems Medicine, "a journal at the confluence of family therapy, systems theory, and modern medicine." (Quite appropriately, almost inevitably, Susan and Tom Campbell became co-editors of that journal when Don retired from the editorship in 1995.)

Rather than just grafting on family therapy-oriented concepts to medical concepts, Susan collaborated with Tom and with Dave Seaburn to figure out how to translate systems theory to the practice of primary care, published in 1990 as "A Manual for Medical Providers."

Then in that same year, at the Costa Rica meeting of Family Process Advisory Editors, Susan talked with Jeri Hepworth and Bill Doherty. They realized that they had been working to bring family systems ideas to the attention of medical providers, but that very few of their family therapy/ mental health colleagues knew the first thing about how to put biopsychosocial concepts into psychotherapy practice. The three of them happened to be flying on to a Family Medicine meeting. By the time they touched ground, they had drafted the outline of Medical Family Therapy, published in 1992. This volume challenged the absence of the biological domain from the practice and teaching of family therapy-a challenge, I must add, to which there is still an inadequate response in most degree-granting marriage and family therapy training programs.

Susan and her colleagues have given extra effort to consultation and therapy with patients and families who are commonly rejected by both psychotherapists and physicians. This includes somatizing patients, who do not present with anxiety, depression, or relationship problems but with numerous physical complaints that either do not make physiologic sense or are grossly in excess of what would be expected from physical findings. "The art of medical family therapy with somatizing patients and families involves collaborative negotiation and co-creation of therapeutic stories that are mutually acceptable to the patient, the family, the therapist, and the medical provider" (McDaniel, Hepworth, & Doherty, 1995).

For most of the last twenty years, Susan has been conducting numerous workshops and training programs in which she has progressively refined methods of teaching integrative approaches to family therapy and medical care. Published or in press, she has co-authored or co-edited 10 books that spell out details of the concepts and therapeutic techniques that she and colleagues have collaboratively developed. Tom Campbell has commented that it is "incredible how hard she works. Sometimes junior and even senior faculty find it hard to keep up to speed with her." Important research with Tom that is nearing publication is a study of distressed high utilizers of healthcare, followed longitudinally to evaluate changes in physical and mental health and the cost-effectiveness of collaborative care.

Gradually, the collaborative model for family healthcare is making interdisciplinary inroads. The meetings of the Society for Teachers of Family Medicine and the Collaborative Family Healthcare Coalition have been important vehicles for carrying forward this mission. Across these and other professional groups and disciplines, Susan has retained an identity both as a bona fide family therapist, having taken significant roles both with AFTA and AAMFT, and as a leading family psychologist in the American Psychological Association. Internationally, she has been highly sought as a speaker; Medical Family Therapy has been translated into Portuguese, Romanian, and German.

But it is in her lucid, often emotionally compelling writing that Susan has made her most innovative contributions. A personal favorite of mine is the book, again co-edited with Hepworth and Doherty, The Shared Experience of Illness, which explicitly gives attention to the experience of the contributors both as therapists and as patients in healthcare systems. Susan's intense, lively, often humorous involvement in therapy, teaching, and research planning is the quality that most endears her to colleagues. Dave Seaburn has lightly summarized his experience with her: "When I think of Susan, I think of deep thoughts, long nails, great clothes, broad vision, persistence, perspective, commitment; I think of broad shoulders and excellent mentoring; I think of creativity and humor and intensity and productivity; I learned that Susan can take a 'might be'and turn it into an actuality better than anyone I have ever met."

I congratulate my dear friend Susan McDaniel upon receiving this award from AFTA and praise AFTA for giving her this well-deserved recognition.

REFERENCES

• Engel, G.L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136.
• Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137, 535-544.
• McDaniel, S.H., Campbell, T.L., & Seaburn, D.B. (1990). Family-oriented Primary Care: A Manual for Medical Providers. New York: Springer-Verlag.
• McDaniel, S.H., Hepworth, J., & Doherty, W. (1992). Medical Family Therapy: A Biopsychosocial Approach to Families with Health Problems. New York: Basic Books.
• McDaniel, S.H., Hepworth, J., & Doherty, W. (1995). Medical family therapy with somatizing patients: The co-creation of therapeutic stories. In R.H. Mikesell, D-D. Lusterman, & S.H.McDaniel (eds.), Integrating Family Therapy: Handbook of Family Psychology and Systems Theory. Washington, D.C.: American Psychological Association, pp. 377-388.
• McDaniel, S.H., Hepworth, J., & Doherty, W. (1997). The Shared Experience of Illness: Stories of Patients, Families, and their Therapists. New York: Basic Books.